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R13972PI: Updates to Chapter 6, Sections 6.2 of Publication (Pub) 100-08 - Program Integrity Manual (PIM) to Include Allowed Practitioners in the Home Health Manual Instruction
Effective date
Nov 2, 2026
Identified
Oct 1, 2026
Summary
Effective November 2, 2026, Medicare home health certification rules allow nurse practitioners, clinical nurse specialists and physician assistants to order and certify patients for the Medicare home health benefit and establish the plan of care, following CARES Act section 3708. Review contractors will accept certification documentation from these allowed practitioners, and payment will not be rendered when the documentation used for certification does not show that the patient is or was eligible under 42 CFR 424.22(c).
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What to do
Action · 6 steps
01Already effective November 2, 2026: Billing team: for each home health claim, confirm the certification is signed by the certifying physician or allowed practitioner and certifies that the five certification requirements in 42 CFR 424.22(a)(1) are met, and that the date of the face-to-face encounter is documented as part of the certification.
02Billing team: for a subsequent episode of care, submit all certification documentation together with the recertification documentation.
03Billing team: make sure any home health agency documentation used to support certification is signed off by the certifying physician or allowed practitioner and incorporated into that practitioner's medical record, at or before claim submission.
04Billing team: make sure the plan of care is reviewed and signed by the physician or allowed practitioner at least every 60 days when continuous home care is needed, and place any required narrative immediately before the signature.
05Billing team: check that the diagnoses on the start of care assessment are corroborated by the certifying practitioner's or facility's own medical record, because CMS's Home Health Prospective Payment System Grouper may be used to recode claims.
06If certification requirements are not met, claims for subsequent episodes that require recertification will be non-covered, and if the certification documentation is insufficient, payment will not be rendered.
Original notice
R13972PI: Updates to Chapter 6, Sections 6.2 of Publication (Pub) 100-08 - Program Integrity Manual (PIM) to Include Allowed Practitioners in the Home Health Manual Instruction
cms.gov · Always check the source before changing claims.